Hodgkin's disease

Hodgkin's disease is a type of lymphoma described by Thomas Hodgkin in 1832, and characterized by the presence of Reed-Sternberg cells.

Staging

After Hodgkin's disease is diagnosed, a patient will be staged: that is, they will undergo a series of tests and procedures which will determine what areas of the body are affected. These procedures will always include documentation of their histology, a physical examination, blood tests, chest X-Ray, CT scans or MRI (magnetic resonance imaging) scans of the chest, abdomen and pelvis, and a bone marrow biopsy. Some patients will also require liver biopsy, lymphangiograms, gallium scans, bone scans, and surgical laparotomy, which involves opening the abdominal cavity and visually inspecting for tumors. Surgical laparotomy is now largely of historical significance only.

Related Topics:
X-Ray - CT scan - Magnetic resonance imaging - Liver biopsy - Lymphangiogram - Gallium scan - Bone scan

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On the basis of this staging, the patient will be classified according to a staging classification (the Ann Arbor staging classification scheme is a common one):

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• Stage I is involvement of a single lymph node region (I) or single extralymphatic site (Ie);
• Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe);
• Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes);
• Stage IV is disseminated involvement of one or more extralymphatic organs.

The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage.

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In 1996, an international effort identified seven prognostic factors that accurately predict the success rate of conventional treatment in patients with locally extensive or advanced stage Hodgkin's disease. Freedom from progression (FFP) at 5 years was directly related to the number of factors present in a patient. The 5-year FFP for patients with zero factors is 84%. Each additional factor lowers the 5-year FFP rate by 7%, such that the 5-year FFP for a patient with 5 or more factors is 42%.

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The prognostic factors identified in the international study are:

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• Age >= 45 years
• Stage IV disease
• Hemoglobin < 10.5 mg/dl
• Lymphocyte count < 600/ul or < 8%
• Male sex
• Albumin < 4.0 mg/dl
• White blood count >= 15,000/ul